Replacing foods high in saturated fats with those that have unsaturated fats can reduce a person's chance of developing heart disease as much as cholesterol lowering drugs known as statins, according to new advice from the American Heart Association.
This would mean, for instance, swapping that steak for a healthier avocado, using canola oil instead of butter, and not eating carb-filled junk food.
The new guidance from the heart association is not a leap from past direction, but the group sought a fresh look at the evidence in light of some newer, less scientific studies and dietary fads that officials feared were confusing the public.
How the message about diet is received by patients will largely depend on their doctors' delivery.
While most physicians would agree that heart health depends on a good diet, some suggest there is a bit more wiggle room than the heart association advisory suggests. Other doctors and health care providers believe the advice does not go far enough in explaining what foods can truly protect their patients from heart disease, the nation's leading cause of death.
"This tries to put it all in perspective — the view from 10,000 feet — but sometimes food can still be controversial," said Dr. Michael Miller, director of the University of Maryland Medical Center's Center for Preventive Cardiology. He served on the heart association panel that made the recommendations published this month in the journal Circulation.
It's long been known that consuming less saturated fat lowers people's LDL, or so-called bad cholesterol, which clogs arteries and causes heart attacks and strokes. But the heart association finds that this is only the case when saturated fat is replaced with unsaturated fat and not refined carbohydrates that contain sugar but no fiber. Both unsaturated fat and fiber have been found to help lower cholesterol.
The group says some newer studies mucking up the healthy heart message didn't consider these dietary replacements.
The guidance should be useful to doctors in advising patients, said Miller, who is also a professor of cardiovascular medicine, epidemiology and public health in Maryland's School of Medicine. But he's not a stickler on eliminating all saturated fat. He advises moderation instead.
That means a small, fist-size steak once in a while, two egg whites for every one yoke and even a bit of coconut oil, a culinary darling of late that is mostly saturated fat.
"If you're good most of the time, allow yourself one unhealthy breakfast, lunch and dinner a week," he said. "But don't go nuts and eat a 24-ounce steak."
He also emphasizes making lifestyle changes such as adding regular exercise and reducing stress. He wrote a whole book on the subject called "Heal Your Heart."
Anne Butta credits a good diet, low in calories, salt and fat for the good health of her father, John Henry "Hank" Butta, who visited with Miller recently.
Butta, the former CEO of C&P Telephone of Maryland, now part of Verizon, and the great-great grandfather of four, is trim and quick witted at 89 years old.
The Highlandtown native said he grew up eating big Italian dinners and evolved into a "meat and potatoes" guy. He worked a lot and also spent time serving on advisory commissions for former Gov. William Donald Schaefer, as well as refereeing football games and playing golf.
In 2010, he needed triple bypass surgery. This led him to a diet low in calories, salt and fat, although, he still has the occasional treat at home or restaurant.
"One time a month," he said about how often he now eats a steak. A decade ago, it was "every other meal."
Miller approved of that schedule. He summed up the heart association advice this way:
—Replacing 10 percent of calories from saturated fats (red meat, butter, palm oil) with polyunsaturated fats (safflower and corn oils, walnuts and salmon) reduces risk of heart disease by 50 percent.
—Replacing 10 percent of calories from saturated fats with monounsaturated fats (canola and olive oil, almonds and avocados) reduces risk of heart disease by 30 percent.
—Replacing 10 percent of calories from saturated fats with complex carbohydrates (whole grains, beans and vegetables) reduces risk of heart disease by 18 percent.
—Replacing 10 percent of calories from saturated fats with simple carbohydrates (sugary foods and soft drinks) does not reduce the risk of heart disease.
Still, not all doctors think this is the right message.
Dr. Dana Simpler, an internal medicine doctor at Mercy Medical Center in Baltimore, said the consequences of a poor diet can be so dire that she believes the heart association report was a missed opportunity to warn people about how much all their food matters.
She joins other doctors who advocate for a whole-food, plant-based diet, for which she said there is evidence of reducing the chance of a first or recurrent heart attack close to zero.
That means eating foods that are not processed and have little to no sugar, salt or added oil.
"It continues to surprise me that the AHA makes such modest diet recommendations for preventing our number one killer — heart disease," she wrote in an email. "Simply substituting saturated fats (bacon, red meat, butter) with unsaturated fats (vegetable oils) reduces heart attacks by 30 percent, but, what about the other 70 percent that still have life threatening heart disease?"
She conceded that a plant-based diet is not easy to follow, "and many people may decide it is too hard for them, but at least let the American public know that there is a diet that will prevent and reverse heart disease almost 100 percent."
Dr. Seth Martin, co-director of the John Hopkins Hospital's Advanced Lipid Disorders Center, said he'd like all his patients to eat so well but said "perfection" is tough to achieve. He encourages them to do what they can, from starting with one change or adopting the Mediterranean diet or the DASH diet, which both center on low-fat, whole-grain and plant-based foods.
The new heart association advice will help him steer patients to food they can substitute for what they should give up.
"I like the idea of replacing something with something," he said. "We're always talking about don't eat this and don't eat that, but here they're talking about what is healthy. Diets are complicated and confusing to people and it's nice to have clear guidance on the topic...
But I imagine there is still going to be some ongoing debate."